Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients: The Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study

Tariq Shafi, Bernard Jaar, Laura C. Plantinga, Nancy E. Fink, John H. Sadler, Rulan S. Parekh, Neil R. Powe, Josef Coresh

Research output: Contribution to journalArticle

Abstract

Background: Residual kidney function (RKF) is associated with improved survival in peritoneal dialysis patients, but its role in hemodialysis patients is less well known. Urine output may provide an estimate of RKF. The aim of our study is to determine the association of urine output with mortality, quality of life (QOL), and inflammation in incident hemodialysis patients. Study Design: Nationally representative prospective cohort study. Setting & Participants: 734 incident hemodialysis participants treated in 81 clinics; enrollment, 1995-1998; follow-up until December 2004. Predictor: Urine output, defined as producing at least 250 mL (1 cup) of urine daily, ascertained using questionnaires at baseline and year 1. Outcomes & Measurements: Primary outcomes were all-cause and cardiovascular mortality, analyzed using Cox regression adjusted for demographic, clinical, and treatment characteristics. Secondary outcomes were QOL, inflammation (C-reactive protein and interleukin 6 levels), and erythropoietin (EPO) requirements. Results: 617 of 734 (84%) participants reported urine output at baseline, and 163 of 579 (28%), at year 1. Baseline urine output was not associated with survival. Urine output at year 1, indicating preserved RKF, was independently associated with lower all-cause mortality (HR, 0.70; 95% CI, 0.52-0.93; P = 0.02) and a trend toward lower cardiovascular mortality (HR, 0.69; 95% CI, 0.45-1.05; P = 0.09). Participants with urine output at baseline reported better QOL and had lower C-reactive protein (P = 0.02) and interleukin 6 (P = 0.03) levels. Importantly, EPO dose was 12,000 U/wk lower in those with urine output at year 1 compared with those without (P = 0.001). Limitations: Urine volume was measured in only a subset of patients (42%), but agreed with self-report (P <0.001). Conclusions: RKF in hemodialysis patients is associated with better survival and QOL, lower inflammation, and significantly less EPO use. RKF should be monitored routinely in hemodialysis patients. The development of methods to assess and preserve RKF is important and may improve dialysis care.

Original languageEnglish (US)
Pages (from-to)348-358
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume56
Issue number2
DOIs
StatePublished - 2010

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Chronic Kidney Failure
Renal Dialysis
Quality of Life
Urine
Inflammation
Mortality
Kidney
Erythropoietin
C-Reactive Protein
Survival
Interleukin-6
Peritoneal Dialysis
Self Report
Dialysis
Cohort Studies
Demography
Prospective Studies

Keywords

  • End-stage renal disease
  • hemodialysis
  • inflammation
  • mortality
  • quality of life
  • residual kidney function

ASJC Scopus subject areas

  • Nephrology
  • Medicine(all)

Cite this

Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients : The Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study. / Shafi, Tariq; Jaar, Bernard; Plantinga, Laura C.; Fink, Nancy E.; Sadler, John H.; Parekh, Rulan S.; Powe, Neil R.; Coresh, Josef.

In: American Journal of Kidney Diseases, Vol. 56, No. 2, 2010, p. 348-358.

Research output: Contribution to journalArticle

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abstract = "Background: Residual kidney function (RKF) is associated with improved survival in peritoneal dialysis patients, but its role in hemodialysis patients is less well known. Urine output may provide an estimate of RKF. The aim of our study is to determine the association of urine output with mortality, quality of life (QOL), and inflammation in incident hemodialysis patients. Study Design: Nationally representative prospective cohort study. Setting & Participants: 734 incident hemodialysis participants treated in 81 clinics; enrollment, 1995-1998; follow-up until December 2004. Predictor: Urine output, defined as producing at least 250 mL (1 cup) of urine daily, ascertained using questionnaires at baseline and year 1. Outcomes & Measurements: Primary outcomes were all-cause and cardiovascular mortality, analyzed using Cox regression adjusted for demographic, clinical, and treatment characteristics. Secondary outcomes were QOL, inflammation (C-reactive protein and interleukin 6 levels), and erythropoietin (EPO) requirements. Results: 617 of 734 (84{\%}) participants reported urine output at baseline, and 163 of 579 (28{\%}), at year 1. Baseline urine output was not associated with survival. Urine output at year 1, indicating preserved RKF, was independently associated with lower all-cause mortality (HR, 0.70; 95{\%} CI, 0.52-0.93; P = 0.02) and a trend toward lower cardiovascular mortality (HR, 0.69; 95{\%} CI, 0.45-1.05; P = 0.09). Participants with urine output at baseline reported better QOL and had lower C-reactive protein (P = 0.02) and interleukin 6 (P = 0.03) levels. Importantly, EPO dose was 12,000 U/wk lower in those with urine output at year 1 compared with those without (P = 0.001). Limitations: Urine volume was measured in only a subset of patients (42{\%}), but agreed with self-report (P <0.001). Conclusions: RKF in hemodialysis patients is associated with better survival and QOL, lower inflammation, and significantly less EPO use. RKF should be monitored routinely in hemodialysis patients. The development of methods to assess and preserve RKF is important and may improve dialysis care.",
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author = "Tariq Shafi and Bernard Jaar and Plantinga, {Laura C.} and Fink, {Nancy E.} and Sadler, {John H.} and Parekh, {Rulan S.} and Powe, {Neil R.} and Josef Coresh",
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T2 - The Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study

AU - Shafi, Tariq

AU - Jaar, Bernard

AU - Plantinga, Laura C.

AU - Fink, Nancy E.

AU - Sadler, John H.

AU - Parekh, Rulan S.

AU - Powe, Neil R.

AU - Coresh, Josef

PY - 2010

Y1 - 2010

N2 - Background: Residual kidney function (RKF) is associated with improved survival in peritoneal dialysis patients, but its role in hemodialysis patients is less well known. Urine output may provide an estimate of RKF. The aim of our study is to determine the association of urine output with mortality, quality of life (QOL), and inflammation in incident hemodialysis patients. Study Design: Nationally representative prospective cohort study. Setting & Participants: 734 incident hemodialysis participants treated in 81 clinics; enrollment, 1995-1998; follow-up until December 2004. Predictor: Urine output, defined as producing at least 250 mL (1 cup) of urine daily, ascertained using questionnaires at baseline and year 1. Outcomes & Measurements: Primary outcomes were all-cause and cardiovascular mortality, analyzed using Cox regression adjusted for demographic, clinical, and treatment characteristics. Secondary outcomes were QOL, inflammation (C-reactive protein and interleukin 6 levels), and erythropoietin (EPO) requirements. Results: 617 of 734 (84%) participants reported urine output at baseline, and 163 of 579 (28%), at year 1. Baseline urine output was not associated with survival. Urine output at year 1, indicating preserved RKF, was independently associated with lower all-cause mortality (HR, 0.70; 95% CI, 0.52-0.93; P = 0.02) and a trend toward lower cardiovascular mortality (HR, 0.69; 95% CI, 0.45-1.05; P = 0.09). Participants with urine output at baseline reported better QOL and had lower C-reactive protein (P = 0.02) and interleukin 6 (P = 0.03) levels. Importantly, EPO dose was 12,000 U/wk lower in those with urine output at year 1 compared with those without (P = 0.001). Limitations: Urine volume was measured in only a subset of patients (42%), but agreed with self-report (P <0.001). Conclusions: RKF in hemodialysis patients is associated with better survival and QOL, lower inflammation, and significantly less EPO use. RKF should be monitored routinely in hemodialysis patients. The development of methods to assess and preserve RKF is important and may improve dialysis care.

AB - Background: Residual kidney function (RKF) is associated with improved survival in peritoneal dialysis patients, but its role in hemodialysis patients is less well known. Urine output may provide an estimate of RKF. The aim of our study is to determine the association of urine output with mortality, quality of life (QOL), and inflammation in incident hemodialysis patients. Study Design: Nationally representative prospective cohort study. Setting & Participants: 734 incident hemodialysis participants treated in 81 clinics; enrollment, 1995-1998; follow-up until December 2004. Predictor: Urine output, defined as producing at least 250 mL (1 cup) of urine daily, ascertained using questionnaires at baseline and year 1. Outcomes & Measurements: Primary outcomes were all-cause and cardiovascular mortality, analyzed using Cox regression adjusted for demographic, clinical, and treatment characteristics. Secondary outcomes were QOL, inflammation (C-reactive protein and interleukin 6 levels), and erythropoietin (EPO) requirements. Results: 617 of 734 (84%) participants reported urine output at baseline, and 163 of 579 (28%), at year 1. Baseline urine output was not associated with survival. Urine output at year 1, indicating preserved RKF, was independently associated with lower all-cause mortality (HR, 0.70; 95% CI, 0.52-0.93; P = 0.02) and a trend toward lower cardiovascular mortality (HR, 0.69; 95% CI, 0.45-1.05; P = 0.09). Participants with urine output at baseline reported better QOL and had lower C-reactive protein (P = 0.02) and interleukin 6 (P = 0.03) levels. Importantly, EPO dose was 12,000 U/wk lower in those with urine output at year 1 compared with those without (P = 0.001). Limitations: Urine volume was measured in only a subset of patients (42%), but agreed with self-report (P <0.001). Conclusions: RKF in hemodialysis patients is associated with better survival and QOL, lower inflammation, and significantly less EPO use. RKF should be monitored routinely in hemodialysis patients. The development of methods to assess and preserve RKF is important and may improve dialysis care.

KW - End-stage renal disease

KW - hemodialysis

KW - inflammation

KW - mortality

KW - quality of life

KW - residual kidney function

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